More than any other forensic area, the interaction between the justice
system, governmental authorities, and the mental health professions in dealing
with child sexual abuse has the greatest potential for iatrogenic harm to
individuals, adults and children, the family, and the society. The entire
structure and system dealing with sexual abuse struggles to make the classification
decisions-sexual abuse or not sexual abuse. Once that decision is made,
the consequences to every person involved, all participating institutions,
relevant social structures, and the nation inexorably march on. We suggest
there is more pseudoscience, more poor science, and greater misunderstanding
of what is scientific and what is not in this system than in any other.
We suggest there is more error, more foolishness, and more poor practice
by legal, judicial, medical, psychological, social work, and bureaucratic
professionals in dealing with allegations of sexual abuse than any other
social issue. There is greater and sharper polarization, more bitter acrimony,
more intense emotional involvement, and deeper and more alienating divisiveness
in all the professions involved in responding to accusations of sexual abuse
than in any other arena (Ceci, 1994; Ceci and Bruck, 1993a).

However, there is one goal-increased accuracy-which everyone should agree
on. The justice system, science, bureaucracies, and institutions may be
aimed at many different goals and purposes but no participant player can
disagree with the value of striving to increase the accuracy of the classification
decisions made. There can be no denial that actual benefit to all people
is advanced by increased accuracy.

The need to unite about the goal of increased accuracy is underscored by
the fact that every scientific analysis we have found of the level and type
of error made by the various scientific and mental health disciplines in
the effort to deal with allegations of child abuse reaches the same conclusion.
The error is massive, unacceptable, and in the direction of false positives-decisions
that there is abuse when there is not (Abel et al., 1994; Altemeier et al.,
1984; Caldwell et al., 1988; Gambrill, 1990; Horner, 1992; Horner and Guyer,
1991a, 1991b; Kotelchuck, 1982; Lindsay and Read, 1994; Melton, 1994; Milner
et al., 1984; Paradise, 1989; Realmuto et al., 1990; Schachter, 1985; Starr,
1979; Wakefield and Underwager, 1988a; Zeitlin, 1987). The lowest ratio
is 3 false positives to 1 true positive while the highest is over 200 to
1. Horner and Guyer (1991a, 1991b) demonstrate a ratio of 21 false positives
to 1 false negative. Such unanimity across 16 years, different countries,
and different areas of practice and technique, is rare in science. It strongly
suggests that this system does more harm than good. The need for increasing
the accuracy of the decisions made is imperative.

Mental health professionals often use unsupported interview techniques
when interviewing children. Although the anatomical dolls are most frequently
used, books, puppets, drawings, projective cards, play dough, games, and
play therapy are also used (Kendall-Tackett, 1992). None of these are reliable
or valid for assessing possible sexual abuse. They have not shown acceptable
validity or reliability for any scientific assessment purpose. Their use
is apt to contaminate the statements children may make, especially if the
the interviewer encourages the child "to pretend." Experts who
have used such techniques should be challenged to produce the scientific
evidence supporting their proper and appropriate use for assessment along
with any contrary scientific evidence.

Psychological testing is discussed in detail elsewhere in these volumes
so we will limit ourselves here to testing in cases involving sexual abuse
allegations. Attorneys should obtain all the raw test data underlying any
reports and conclusions and then have their own expert examine them. We
frequently encounter reports and depositions in which claims are made that
simply are not supported by the test results (Wakefield and Underwager,
1993). In addition, tests may be incorrectly scored and misstatements made.

Ralph Underwager, Ph.D., and Hollida Wakefield, M.A. are licensed psychologists
at the Institute for Psychological Therapies in Northfield, Minnesota. They
have extensive experience in consulting and testifying in cases of alleged
sexual abuse. They have presented workshops and seminars and have written
numerous articles on the topic of sexual abuse allegations. They are the
authors of Accusations of Child Sexual Abuse () (), published by
C. C. Thomas
in 1988; The Real World of Child Interrogations (), published by
C. C. Thomas in 1990; and Return of the Furies: An Investigation into Recovered
Memory Therapy (), published by Open Court in 1994. They publish a journal,
Issues in Child Abuse Accusations.